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Pain in the ear (otalgia) is a very common condition. The cause, severity and treatment, however, can vary greatly.

Ear pain may also be accompanied by hearing loss, ear discharge and sore throat.

Broadly speaking, ear pain can originate from the external ear, middle ear, temporal bone (the bone encasing the structures of the ear) or is referred from elsewhere.

Causes of Ear Pain
Common External Ear Conditions

  1. Impacted Ear Wax
    1. Often associated with ear digging with a cotton bud, which pushes the wax deep into the ear canal, impacting it against the ear canal and ear drum
    2. This causes pain and some hearing loss
  2. Infection of the External Ear
    1. Excoriation (repetitive picking) of the external ear canal skin can lead to secondary infection by bacteria or fungi
    2. Bacterial infections are painful while fungal infections are intensely itchy
    3. The debris will be suctioned out and the patient will be treated with antibiotic eardrops

  3. Foreign Bodies in the Ear
    1. E.g. when small insects accidentally crawl into the ear, causing a lot of physical trauma as the insect tries to crawl back out
Common Middle Ear Conditions

  1. Middle Ear Infection
    1. Common in young children
    2. May be due to ascending infection from the nose via the Eustachian tube
    3. Causes pain and possibly fever

  2. Barotrauma
    1. E.g. when people experience pain in their ears during a flight descent or when scuba diving
    2. Due to negative pressure being created in the middle ear
    3. Failure to equalise the pressure (e.g. by “popping” the ears) could result in pain and bleeding in the middle ear
Temporal Bone Infections

Elderly diabetic patients are predisposed to Malignant Otitis Externa (MOE):

  1. A serious infection of the temporal bone (bone surrounding the ear)
  2. If untreated, it can lead to the paralysis of some nerves controlling facial movement and the erosion of major blood vessels to our brain
  3. Associated with intense headaches, sometimes with hearing loss and ear discharge.
Referred Pain

Referred pain refers to how the inflammation of nearby organs may cause pain in the ear as a result of a network of interconnecting sensory nerves.

E.g. A sore throat can result in ear pain

Know Your ENT Specialist
Dr Paul Mok
Senior Consultant ENT Surgeon
MBBS, FRCS (Glasgow), FAMS (ORL)

Dr Paul Mok Kan Hwei is a certified specialist in Otolaryngology, Head and Neck Surgery (ENT) and has had a distinguished career in public service for the past 23 years.

He cares for patients with a wide variety of ENT conditions including managing patients with nasal allergies, sinus infections, ear problems and swellings in the head and neck region. His special areas of interests are in Voice, Swallowing and managing patients with Obstructive Sleep Apnea.